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Request Information

Thank you for your interest in Memorial Lutheran School!

Please fill out the form below and our Office of Admission will contact you to provide your requested information. 


 

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • Last Name *
  • First Name *
  • Middle Name
  • Salutation *
  • Email Address *
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
  • Second Parent / Guardian
    (leave blank if not applicable)
  • Last Name *
  • First Name *
  • Middle Name
  • Salutation *
  • Email Address *
  • Work Phone
    (Ex: 999-999-9999)
  • Cell Phone
    (Ex: 999-999-9999)
Home Address
  • Street Address *
  • City *
  • Country *
  • State *
  • Zip *
  • Home Phone *
    (Ex: 999-999-9999)
  • How Did You Hear About Memorial Lutheran School? *
    Details:
  • If your inquiry is regarding the infant or two year old program, please list the desired start date. 

    (mm/dd/yyyy)
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
    Male    Female
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •